心房颤动环肺静脉电隔离术后房性心律失常的再消融治疗  

The mechanism and re-ablation of recurrent atrial arrhythmias after ablation of atrial fibrillation using electroanatomic mapping system and double LASSO technique

作　　者：赵宁[1] 王祖禄[1] 梁延春[1] 梁明[1] 韩雅玲[1] 苗驰[1] 王雪[1] 

机构地区：[1]辽宁医学院研究生培训基地沈阳军区总医院心内科,沈阳市110016

出　　处：《中国介入心脏病学杂志》2007年第4期190-193,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨应用三维电解剖(Carto)系统引导左房(left atrium,LA)内环肺静脉(pulmo-naryvein,PV)消融治疗心房颤动(房颤)后复发房性心律失常的可能原因和再消融治疗。方法共对77例房颤患者进行环肺静脉电隔离术消融治疗,其中男性58例,20～76岁;阵发性房颤56例,持续性房颤21例。穿刺2～3次房间隔送入2～3支2·67mm(8F)长鞘至LA,送入1～2支Lasso导管入PV。应用Carto-XP系统,3·5mm生理盐水灌注消融导管,在LA内建立三维电解剖结构图。行PV选择性造影标识出PV口。在沿PV口外0·5～1·0cm的LA,设定围绕左或右侧上、下PV的环状消融线,消融终点为PV-LA电隔离。结果71/77例左侧和右侧PV-LA均达到电隔离,6/77例仅单侧PV-LA电隔离。复发病例中,14例再次消融,心电图或动态心电图示房性心动过速(房速)8例,房速-房颤5例,典型心房扑动1例。13例(93%)有左和/或右侧PV-LA传导恢复,其中左、右两侧均恢复8例,左侧和右侧恢复分别为3例和2例。7例患者在术中记录到左房房速,均起源于PV。13例再次消融均达到PV-LA电隔离,1例典型心房扑动达到三尖瓣峡部双向传导阻滞;随访3～30个月,其中12例无房性心律失常发作。结论采用Carto系统引导环同侧PV线性消融治疗房颤安全有效,PV-LA传导恢复可以是房颤消融后复发房性心律失常的主要机制,再次消融达到PV-LA电隔离可进一步提高房颤消融的成功率。Objective To investigate the possible mechanism and re-ablation of recurrent atrial arrhythmias after atrial fibrillation （AF） ablation by utilizing the Carto system and double LASSO technique. Methods A total of 77 AF patients were enrolled and among them, 56 with paroxysmal AF and 21 with persistent AF. Eight-F Swartz long sheaths were positioned in the left atrium by transseptal technique. One to two LASSO catheters were placed in the ipsilateral pulmonary veins （PV）. The anatomy of the left atrium and PV was established using the Carto system. PV selective venography was carried out to identify the PV ostium. Continuous circular lesions （CCL） were made at the left atrium at 0. 5 to 1.0 cm outside the PV ostium. Irrigated radiofrequecy energy was delivered in all the patients. The end point of the CCL was defined as absence of all PV spikes documented with LASSO catheters within the ipsilateral PVs. Results A repeat ablation was performed in 14 patients who experienced highly symptomatic atrial tachyarrhythmia. During the repeat procedures, conduction gaps in the previous CCL were found in 13 out of the 14 patients, and a typical atrial flutter was found in the other patient which was eliminated by ablation of the tricuspid isthmus. During the second procedure, pulmonary vein tachycardia was demonstrated in 7 patients. The pulmonary vein tachycardia activated the LA via the conduction gaps. All conduction gaps were successfully ablated by irrigated RF applications. After the second procedure, 12 out of the 14 patients were free of AF during 3 to 30 months of follow-up. Conclusion Continuous circular lesions （CCL） in the left atrium utilizing the Carto system and double LASSO technique had a high success. In patients with recurrent atrial tachyarrhythmia after CCLs, recovered PV conduction is a main cause for the recurrence.

关 键 词：心房颤动 导管消融术 肺静脉 

分 类 号：R541.75[医药卫生—心血管疾病]